Golden Home Care Center

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived at 8:35 AM, LPA was met by Administrator Letitia Isai she was informed of the purpose of the visit. There are currently no cases of COVID-19 within the facility. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed proper signage throughout the facility, sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor resident(s) regularly for any changes in condition and to subsequently notify the resident(s) physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided to the administrator Letitia Isai.the state’s words, verbatim · CDSS document, Jul 7, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Melody Brown arrived at the facility 06/24/2022 at 08:45 AM unannounced in order to initiate a Case Management visit. LPA Brown met with Administrator/Licensee Letitia Isai and LPA Brown explained the purpose of today's visit. During the visit last 03/08/2022 at 11:30 AM, LPA Brown requested Licensee/Administrator Isai to lock R1's room door knob and also requested to open R1's room from the outside and LPA Brown observed that LIcensee/Administrator Isai is having difficulty opening R1's room door. LPA Brown observed R1's door knob in disrepair. LPA Brown informed Licensee/Administrator Isai that LPA Brown will be issuing a deficiency as this poses immediate Health, Safety or Personal Rights risks to residents in care. Licensee/Administrator Isai informed LPA Brown that new door knobs will be installed on all resident bedrooms after the visit. In addition, LPA Brown reviewed facility's incident reports and LPA Brown observed that no incident report was submitted regarding R1's fall or R1's observed scratch or bluish mark on R1's forehead. Also, LPA Brown noticed that the facility's last incident report submitted was 12/21/2020. LPA Brown informed Licensee/Administrator Isai that all incidents at the facility involving residents and staff must be reported to Community Care Licensing Division (CCLD) and LPA Brown will be issuing a deficiency for this item as this poses a potential Health, Safety or Personal Rights risk to residents in care. Moreover, interview with Staff 2 (S2) last 06/16/2022 at 03:53 PM indicated that no awake staff on duty at the facility to provide night supervision to the residents in care at all times. S2 reported "I worked from 8:00 PM to 8:00 AM. I checked the residents every two (2) or three (3) hours. Then, If everything's ok, I sleep at the sofa." *** Continuation on LIC809C *** LPA Brown reviewed the facility's LIC500 Personnel Report and it indicated S1 works 8:00 AM to 08:00 PM and S2 works 8:00 PM to 08:00 AM. LPA Brown explained to Licensee/Administrator Isai that if they have resident with dementia like R1 in reference to R1's pre-admission appraisal, and physician report (LIC624), it requires awake night supervision at all times. Thus, LPA Brown will be issuing a deficiency for this item as this poses an immediate Health, Safety or Personal Rights risk to clients in care. An exit interview was conducted where this report (LIC809), LIC809D and Appeal Rights were discussed and provided to Licensee/Administrator Letitia Isai.the state’s words, verbatim · CDSS document, Jun 24, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303 · Plan of correction due date: Apr 12, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. Based on observation, interview and record review, the Licensee did not comply with the section cited above by having Resident 1 doorknob in disrepair due to it being difficult to open which poses an immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2022

Plan of correction: Licensee stated that they will replace all residents room doorknobs and will submit proof of purchase/installation to LPA Brown by POC due date. Licensee already replaced all residents room doorknob during the visit, POC cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(c)(4)(A) · Plan of correction due date: Jun 25, 2022

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia ...(4) There is an adequate number of direct care staff to support each resident’s ... (A) In addition to requirements specified in Section 87415, Night Supervision, ... Based on observation, interview and record review, the Licensee did not comply with the section cited above by not having at least one (1) night person always awake and on duty at the facility due to R1’s primary which poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2022

Plan of correction: Licensee stated to have one (1) awake night person, on duty at the facility at all times and submit proof (LIC500) to LPA Brown by POC due date. Licensee stated to submit Statement of Understanding on CCR 87705(c)(4)(A) to LPA Brown by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Apr 18, 2022

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven ... Based on observation, interview and record review, the Licensee did not comply by not reporting R1's incident to Community Care Licensing Department (CCLD) which poses a potential risk to resident in care.the state’s words, verbatim · CDSS document, Jun 24, 2022

Plan of correction: Licensee stated to report all incidents at the facility to CCLD. Also, Licensee will submit Statement of Understanding to 87211 Reporting Requirements (a)(1) to LPA Melody Brown by POC due date.

Allegation investigated: Resident fell while in care. Facility has inappropriate locking devices on resident's bedroom door.

Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit 04/11/2022 at 09:15 AM to deliver the findings for the above allegations. LPA Brown was greeted and granted entrance to the facility by Licensee/Administrator Letitia Isai. LPA Brown explained the purpose of today's visit. The investigation consisted of file review, observation, and interviews with relevant parties. LPA Brown toured the facility, conducted interviews, and reviewed facility files. The first allegation indicates resident fell while in care. LPA Brown conducted interviews with resident, staffs and hospice nurse. Resident, staffs and hospice nurses interviews indicated that resident fell while in care last 02/22/2022. Also, Hospice Care Nurse indicated that Administrator Isai reported last 02/24/2022 that R1 fell last 02/22/2022, and unable to determine when R1 fell. **** Continuation in LIC9099C **** Unsubstantiated Interview with S1 indicated S1 saw scratch on R1’s forehead while interview with R2 indicated that R2 saw blue marking on R1’s forehead the morning of 02/23/2022. Both S1 and R2 indicated that they did not witness R1’s fall. LPA Brown was not able to corroborate the allegation that resident fell while in care. The second allegation indicates facility has inappropriate locking devices on residents’ bedroom door. LPA conducted interviews with resident, staffs and hospice care nurses. Resident, staffs and hospice nurses interviews indicated that the facility do not have inappropriate locking devices on residents room. LPA Brown was not able to corroborate the allegation that the facility has inappropriate locking device on residents’ room. Therefore, the allegation resident fell while in care (allegation #1) and facility has inappropriate locking devices on residents’ bedroom door (allegation #2) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. An exit interview was conducted where this report (LIC9099) was discussed and provided to Licensee/Administrator Letitia Isai. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted where this report (LIC9099) was discussed and provided to Licensee/Administrator Letitia Isai.the state’s words, verbatim · CDSS document, Apr 11, 2022 · control 18-AS-20220302123752

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Apr 12, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation, interview and record review, the Licensee did not comply by having resident 1 door knob in disrepair due to being difficult to open which poses an immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 11, 2022

Plan of correction: Licensee stated that they will replace all residents room door knobs and will submit proof of purchase/installation to LPA Brown by POC due date. Licensee already replaced all residents room door knob during the visit, POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Apr 18, 2022

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven ... Based on observation, interview and record review, the Licensee did not comply by not reporting the incident that resdient 1 fell last 02/22/20022 to Community Care Licensing Department (CCLD) which poses a potential risk to resident in care.the state’s words, verbatim · CDSS document, Apr 11, 2022

Plan of correction: Licensee stated to report all incidents at the facility to CCLD. Also, Licensee will submit Statement of Understanding to 87211 Reporting Requirements (a)(1) to LPA Melody Brown by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived at 9:02 AM, LPA were met by Administrator Letitia Isai and explained the purpose of the visit. Present in the facility during time of visit were two (2) staff as well as three (3) residents. There are currently no cases of COVID-19 within the facility. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed proper signage throughout the facility, sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor resident(s) regularly for any changes in condition and to subsequently notify the resident(s) physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 5, 2021